A&P Upper Limb II:

When relaxed, fingers are in slight flexion. How do the lumbricals and interossei fix this?

Their use in conjunction with extensor digitorum allows for extended digits.

What are the intrinsic muscles of the hand?

Thenar and hypothenar

course of radial artery in forearm

Travels medial to brachioradialis muscle. At the wrist it lies on surface of radius before coursing into superficial and deep palmar arches

The adductor pollicis is innervated by the _______ nerve

Ulnar nerve

Positive froment sign may indicate?

Ulnar nerve injury

What nerve injury is this: Hyperextended metacarpophalangeal joints, flexed interphalangeal joints

Ulner nerve injury.

The dorsal interossei __________(an action) and the palmar _______(also an action). Which digits on the dorsal and palmar side?

1. Abduct(DAB)2, 3 and 4 2. Adduct(PAD)2, 4 and 5

What is the action and innervation of abductor pollicis longus?

1. Abduction of pollex and extension at CMC joint 2. Posterior interosseous nerve

What are the thenar muscles?

1. Abductor pollicis brevis, 2. flexor pollicis brevis, 3. opponens pollicis 4. Adductor pollicis

What is ABL? What innervates all three?

1. Abductor pollicis longus 2. Extensor pollicis brevis 3. Extensor pollicis longus 4. Posterior interosseous nerve

What are the 2 compartments of the upper limb. What do they do? What are their innervation and blood supply?

1. Anterior arm compartment: -Muscles flex the shoulder or arm -Innervation: musculocutaneous nerve -Blood supply: brachial artery 2. Posterior arm compartment: -Muscles extend the elbow -Innervated by radial nerve -Blood supply: profunda brachii

What innervates the deep flexors of the anterior forearm?

1. Anterior interosseous nerve( from median nerve)

_______ ________ ________ is a branch of the median nerve that supplies all the deep muscles of the anterior forearm except for the ulnar half of the flexor digitorum profundus muscle

1. Anterior interosseous nerve.

What muscles surround the musculocutaneous nerve distally? Where does the musculocutaneous nerve emerge and what is it called then?

1. Biceps brachii and brachialis 2. Emerges lateral to the biceps brachii muscle as the lateral cutaneous nerve of the forearm.

What happens to the ulnar nerve in the forearm?

1. Branches to FCU and ulnar half of FDP 2. Gives off Palmar cutaneous nerve to hand 3. Gives off dorsal cutanous nerve to hand

Superficial flexor and pronator muscles arise from _______ ______ _________ on the __________ ___________ of the humerus

1. Common flexor attachment 2. Medial epicondyle

The _______ fascia continous with the antebrachial fascia of the forearm. What is the central thickening called?

1. Deep 2. Palmar aponeurosis

Triceps brachii action and innervation?

1. Elbow: extension of forearm. Shoulder: long head extension resists dislocation of humerus during adduction 2. Radial nerve

Bicep brachii action and innervation

1. Elbow: supination of forearm and flexion Shoulder: flexion, stabilization of humeral head 2. Musculocutaneous nerve

How does the ulnar enter the hand?

1. Enters with ulnar vessels, by passing superficial to the flexor retinaculum in the ulnar canal(between pisiform and hook of hamate)

What is the action and innervation of Extensor Carpi ulnaris?

1. Extension and adduction of hand at carpal joint

What is the action and innervation of Extensor digiti minimi?

1. Extension of 5th digit primarly at MCP, secondarily at IP 2. Deep branch of radial nerve

What is the action and innervation of the extensor indicis?

1. Extension of digit 2; helps extend hand at wrist 2. Posterior interosseous nerve

What is the action and innervation of extensor pollicis longus?

1. Extension of distal phalanx of pollex at DIP and MCP and CMC joints 2. Posterior interosseous nerve

What is the action and innervation of the extensor digitorum?

1. Extension of medial 4 digits primarily at MCP secondarily at IPs 2. Deep branch of radial nerve

What is the action and innervation of extensor pollicis brevis?

1. Extension of proximal phalanx of pollex at MCP joint; extension at CMC joint 2. Posterior interosseous nerve

What in the posterior compartment of the forearm are considered superficial extensors of the forearm

1. Extensor carpi radialis longus 2. Extensor carpi radialis brevis 3. Extensor carpi ulnaris 4. Extensor digitorum 5. Extensor digiti minimi.

What in the posterior compartment of the forearm are considered deep extensors of the forearm?

1. Extensor indicis 2. Abductor pollicis longus 3. Extensor pollicis brevis 4. Extensor pollicis longus 5. Supinator

What is the action and innervation of the flexor carpi radialis?

1. Flexion and abduction of hand 2. median nerve

What is the action and innervation of flexor carpi ulnaris?

1. Flexion and adduction of hand(carpal joint) 2. Ulnar nerve

What is the action and innervation of the flexor digitorum profundus?

1. Flexion of distal phlanges of digits 4 & 5 at DIP Flexion of distal phlanges of digits 2 & 3 at DIPs Anterior interosseous nerve( from median nerve)

What is the action and innervation of flexor pollicis longus?

1. Flexion of phlanges of pollex 2. Anterior interosseous nerve (from median nerve)

The ulnar nerve supplies what muscles? What muscles does it travel through?

1. Flexor carpi ulnaris 2. FCU and FDP with the ulnar artery

What in the anterior compartment of the forearm are considered deep flexors of the forearm?

1. Flexor digitorum profundus 2. Flexor pollicis longus 3. Pronator quadratus

What in the anterior compartment of the forearm are considered intermediate flexors of the forearm?

1. Flexor digitorum superficialas

What is the only muscle in the intermediate muscle group of the anterior compartment of the forearm?

1. Flexor digitorum superficialis

What else is within the central compartment along with the lumbricals?

1. Flexor tendons and their synovial sheaths 2. Superficial palmar arterial arch 3. Digital vessels and nerves

What is the function of the fibrous digital sheath?

1. Hold tendons against the phalanges to prevent them from bowing during finger flexion.

Where does the brachial artery begin?

1. Inferior border of teres major as the distal continuation of the axillary artery

What does the median nerve innervate?

1. Innervates all superficial and intermediate muscles o the anterior compartment of the forearm except for flexor carpi ulnaris

In the palm of the hand, the ulnar nerve innervates all the ________ muscles of the hand not inervated by the median nerve. Its ___________ branch is cutaneous to the palmar surfaces of the medial _____ digits

1. Intrinsic 2. superficial 3. 1.5

What is the common extensor orgin? What is found here?

1. Lateral epicondyle of humerus 2. Extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris

The palmar aponeurosis has both a _______ __________ __________ ________ and a _______ __________ __________ ________ that extend deeply and function as what?

1. Medial fibrous intermuscular septum 2. Lateral fibrous intermuscular septum 3. Creates compartments of the palm

Which nerve arises via contributions from both the lateral and medial cords?

1. Median nerve

Lumbricals 1 & 2 are innervated by the ___________ nerve. How about lumbricals 3 & 4? What do these muscles do?

1. Median nerve 2. Ulnar nerve 3. Flex MCP joint and extend IP joints

Brachialis innervation and action

1. Musculocutaneous nerve 2. Flexion of forearm

Coracobrachialis innervation and action

1. Musculocutaneous nerve (C5, C6, C7) 2. flexion, adduction of arm

________ _____ innervates all muscles of anterior arm. It is considered a terminal branch of what cord? What muscle does it pierce?

1. Musculocutaneous nerve(C5-C7) 2. Terminal branch of Lateral cord 3. Pierces the corachobrachialis

Radial nerve supplies _____ muscles in the hand. What supplies skin on the lateral side of the dorsum of the hand and a small portion of the thenar eminence?

1. No muscles of the hand 2. Superficial radial

What are the hypothenar muscles?

1. Opponens digiti 2. Abductor digiti minimi 3. Flexor digiti minimi brevis

The ________ ______________ continues with the flexor retinaculum and if present, the tendon of palmaris longus muscle

1. Palmar aponeurosis

Prior to entering the carpal tunnel the median nerve gives off what branch? What does this innervate? Once it is in the palm what does the median nerve do?

1. Palmar cutaneous branch 2. Innervates skin of the center of palm 3. Gives off recurrent branch which supplies the thenar eminence muscles(except flexor pollicis brevis). Branches to first 2 lumbricals. Cutanous branches to the skin on the palmar surfaces of the first 3.5 digits

Describe the course of the ulnar nerve

1. Passes posterior to the medial epicondyle of the humerus and enters the forearm by passing through the cubital tunnel between the two heads of the flexor carpi ulnaris muscle

What is the primary source of blood for the posterior forearm?

1. Posterior interosseous artery

What does the brachial artery give off?

1. Profunda brachii a. (deep artery of the arm), which supplies the posterior arm w/ radial nerve 2. Collateral branches that surround elbow 3. Brachial artery continues distally, traveling through the cubital foss and terminates at the level of the radial head, where it bifuractes into the radial and ulnar arteries.

What is the action and innervation of the pronator teres?

1. Pronation and flexion of forearm 2. Median nerve

What is the action and innervation of the pronator quadratus?

1. Pronation of forearm; deep fibers bind radius and ulna together 2. Anterior interosseous nerve(from median nerve)

What in the anterior compartment of the forearm are considered superficial flexors of the forearm

1. Pronator teres 2. Flexor carpi radialis 3. Palmaris longus 4. Flexor carpi ulnaris

All muscles in the superficial muscle group are innervated by ________ except what? What is the exception innervated by?

1. Pronator teres, flexor carpi radialis, palmaris longus are all innervated by the median nerve 2. Flexor carpi ulnaris is innervated by the ulnar nerve

Aconeus innervation and action?

1. Radial nerve 2. Extends the forearm and stabilizes the joint

The thenar muscles are supplied by what branch of the median nerve?

1. Recurrent branch of median nerve.

The __________ fascia consists primarily of fat containing _________ vessels and _______ nerve. What part of the hypothenar eminence does it contain?

1. Superficial 2. Superficial vessels 3. Cutaneous nerve 4. Palmaris brevis

What is the action and innervation of the supinator?

1. Supination of forearm; rotation of radius to turn palm anteriorly or superiorly 2. Deep radial nerve

The deep radial nerve pierces what muscle? What does it emerge distally as?

1. Supinator 2. Posterior interosseous nerve.

The radial nerve is a _____________ ____________ off the posterior cord. How does it enter the posterior arm?

1. Terminal branch 2. Passes through the triangular interval(inferior to teres major; lateral to the logn head of triceps) with the profunda brachii vessels (deep artery and vein of the arm). This neurovascular bundle lies directly on the humeral shaft and spirals around the bone to reach the groove between brachialis and brachioradialis where it will divide into deep and superficial radial nerves.

What is contained within the carpal tunnel?

1. The median nerve 2. Tendon flexor pollicis longus 3. Superficial and deep flexors of the digits.

What are the two thickenings of the antebrachial fascia at the wrist?

1. Transverse palmar ligament and more distal is the flexor retinaculum.

Describe the course of the median nerve.

1. Travels through the arm with the brachial artery and enters the cubital fossa on its medial side. It exits the cubital fossa by passing between the two heads of the pronator teres muscle and travels in the forearm between intermediate and deep muscle layers.

How does the ulnar artery travel throughout the forearm?

1. Travels with the median nerve between the 2 heads of the FDS muscle then moves medially to travel with the ulnar nerve. 2. Travels with the ulnar nerve lateral to the tendon of the FCU 3. Runs superficial to the flexor retinaculum to reach the palmar surface of the hand 4. Branches into common interosseous artery which bifurcates to anterior and posterior interosseous.

The ulnar nerve enters the hand throught the ________ _________. Before it does this it gives off what two branches? What do these provide innervation to?

1. Ulnar canal 2. Palmar cutaneous branch: provides innervation to the skin of the medial side of the palm 3. Dorsal cutaneous branch which provides cutaneous innervation to the skin of the medial side of the dorsum of the hand.

What is the terminal branch of the medial cord?

1. Ulnar nerve (C7/8 - T1)

What is the action and innervation of the palmaris longus?

1. flexion of hand (carpal joint) and tenses palmar aponeurosis. 2. Median nerve

What are the borders of the cubital fossa?

1. pronator teres(medial border) 2. brachioradialis (lateral border

The __________ artery enters the hand _____________ to the flexor retinaculum, just lateral to the __________ bone. What does it give off?

1. ulnar 2. Anterior 3. pisiform 4. Gives off deep palmar branches and continus on the palm as the superficial palmar arterial arch

How can one determine the integrity of the musculocutaneous nerve?

Biceps reflex

What supplies the anterior arm?

Brachial artery

From where does the posterior interosseous artery arise from?

Common interosseous artery in the anterior compartment of the forearm

What holds posterior compartment tendons in place?

Extensor retinaculum

Follow up w/ Lewis regarding extensor expansion. Do we need to know all the tendons? Vinculum breve, longum, etc...

F this

Most tendons are held in place by?

Fascial thickenings

Once the eight tendons of FDP and FDS reach the palmar surface they enter what sheath?

Fibrous digital sheath

Actions of lumbricals and interossei

Flexion of the MCP joints and extension of the DIP and PIP joints

What forms the carpal tunnel roof?

Flexor retinaculum

What compartment and function is this? What layer? 1. Flexor digitorum superficialas

In the anterior compartment of the forearm and are considered intermediate flexor of the forearm

What compartment and function is this? What layer? 1. Pronator teres 2. Flexor carpi radialis 3. Palmaris longus 4. Flexor carpi ulnaris

In the anterior compartment of the forearm are considered superficial flexors of the forearm

What nerve injury causes loss of flexion in digits 1-3?

Median nerve injury

Radial nerve injury results in what defects in the forearm?

No elbow, wrist, finger and thumb extension

What is the action of the Flexor digitorum superficialis? What is its innervation

PIPs: flexion of middle phlanges of middle 4 digits MCPs: flexion of proximal phlanges of middle 4 digits 2.Median nerve

The tendon of the _____ _________ runs superficial to the flexor retinaculum and often blends with the transverse palmar ligament before becoming continous with the palmar fascia

Palmaris longus

_____________ ____________ supplies the posterior compartment of the arm (blood supply)

Profunda brachii

What is the primary source to the deep palmar arterial arch?

Radial artery

Primary contents of the Cubital fossa?

biceps tendon brachial artery median nerve radial nerve

What compartment and function are these? What layer? 1. Flexor digitorum profundus 2. Flexor pollicis longus 3. Pronator quadratus

in the anterior compartment of the forearm are considered deep flexors of the forearm

The interossei are intervated by?

ulnar nerve

What compartment and function are these? What layer? 1. Extensor indicis 2. Abductor pollicis longus 3. Extensor pollicis brevis 4. Extensor pollicis longus 5. Supinator

Posterior comparment, deep extensors of the forearm

What compartment and function are these? What layer? 1. Extensor carpi radialis longus 2. Extensor carpi radialis brevis 3. Extensor carpi ulnaris 4. Extensor digitorum 5. Extensor digiti minimi.

Posterior compartment of the forearm are considered superficial extensors of the forearm

What nerve supplies most of the muscles in the posterior compartment?

Posterior interosseous nerve.

Palmar cutaneous branch of median nerve innervates what?

Skin of central palm before traveling through the carpal tunnel on its way to innervate more muscles in the hand.

What is the major cause of carpal tunnel syndrome?

Swelling of synovial sheaths